13.6: How Common Is Prolapse?

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Pelvic organ prolapse (POP) is a distressingly common condition and 11% of women have a lifetime risk of surgery for this condition. Despite this, its aetiology is poorly understood, and the natural course of prolapse is grasped more in the anecdotal than scientific arena. With an aging population, reconstructive surgery for the management of pelvic organ prolapse (POP) will command increasing resources. Surgery is required to correct symptoms of POP, restore the anatomy, retain bowel, bladder and sexual competence, and be durable. We intuitively perceive that prolapse is the result of aging, vaginal parity, chronic elevation of intra – abdominal pressure and hysterectomy. Following novel anatomical insights occasioned by the cadaver dissections of Delancey and Richardson before him, a new description of prolapse and classification of the staging has emerged.

We have hitherto considered pelvic organ prolapse as consisting of a cystocoele (prolapse of the bladder), uterine or vault prolapse (depending on whether or not the uterus is present), or a rectocoele (prolapse of the rectum). Whilst we suppose that the cystocoele contains the bladder, a vault prolapse consists of the apex of the vagina and a rectocoele contains part of the rectum, this is not always the case.